ARIZONA HEALTH INSURANCE CORE EXAMS
ANSWERS AND QUESTIONS SET A+
✔✔What are the sources of underwriting information? - ✔✔- Application
- MEdical Information Bureau
- Medical Exams and Lab Tests
- Genetic Testing
- Rating Factors
✔✔Producer Report - ✔✔the report that the agent/producer is involved in completing
that asks questions about the length of time that the applicant has been known to the
agent, an estimate of the applicant's income and net worth, and whether the agent
knows of any reason that the contract should not be issued; does not become part of
the entire contract
✔✔Reports on previous insurance information can be obtained from the __________.
Insurers can report on an applicant and receive coded information from any other
applications for insurance submitted to other insurers. - ✔✔Medical Information Bureau
✔✔Information from the __________ cannot be used in and of itself to decline a risk,
but it can give the underwriter important additional information. - ✔✔Medical Information
Bureau
✔✔__________, when required by the insurance company, are conducted by
physicians or paramedics at the insurance companies expense. They are usually not
required in regard to health insurance, thus stressing the importance of the agent in
recording medical information on the application. - ✔✔Medical examinations
✔✔If an insurer requires an applicant to take __________, the insurer must first obtain
the applicant's written consent for the test. The consent form must explain the purpose
of te test, and inform the applicant about the confidentiality of the results. - ✔✔an HIV
test
,✔✔__________ may not be performed without specific, written informed consent of the
subject Results are confidential and may not be released to any party without the
expressed consent of the subject. - ✔✔Genetic testing
✔✔Gene Products - ✔✔refer to gene fragments or DNA sequence information
✔✔Genetic Test - ✔✔an analysis of an individual's DNA, gene products or
chromosomes; intended to indicate susceptibility to illness or other disorders
✔✔When developing remium rates fr a qualified health plan in the individual and small
group markets, insurers may only consider the following rating factors: - ✔✔- whether
the plan or coverage covers an individual or a family
- age (subject to restrictions)
- tobacco use (subject to restrictions)
- rating area (by geographic boundaries)
✔✔What are the categories for Classification of Risks? - ✔✔- preferred
- standard
- substandard
✔✔Preferred - ✔✔risks that reflect a reduced risk of loss and are covered at a reduced
rate
✔✔Standard - ✔✔risks that reflect average exposures and may be insured at standard
rates and premiums
✔✔Substandard - ✔✔risks that reflect an increased risk of loss to the insurer; these
applicants may be able to obtain health insurance coverage at an increased premium
✔✔Why would an applicant be rated substandard? - ✔✔- poor health
- dangerous vocation
- dangerous avocation
✔✔Who's responsibility is it to carefully compare the benefits, limitations and exclusions
found in the current and proposed replacement policy? - ✔✔The agent's
✔✔Who needs to make sure that the current policy is not cancelled before the new
policy is issued? - ✔✔The agent
✔✔Underwriting - ✔✔the process of reviewing applications for insurance and the
information on the application
✔✔Why is underwriting important when replacement is involved? - ✔✔It is the
underwriter's duty to evaluate risk and decide whether or not a person is eligible for
,coverage. The insured may be under the impression that a replacing policy is in their
best interest, but after being evaluated by an underwriter, where premium and risk are
exchanged, an insured may not be paying the same premium or receiving the same
benefits.
✔✔Pre-existing Condition - ✔✔a medical condition for which the insured sought medical
advice or treatment within a specified period of time prior to the policy being issued.
✔✔Health conditions covered under the current policy may not be covered under the
new policy because of __________ limitations, or new waiting periods may be required
in a new policy. - ✔✔Pre-existing condition
✔✔If an issuer decides to discontinue a particluar product, the issuer must: - ✔✔-
provide notice in writing to each plan sponsor or insured of the insured of the
discontinuation at least 90 days before the date it will be discontinued
- offer to each plan sponsor or individual the option to purchase any other health
insurance coverage currently being offered by the issuer
- act uniformly without regard to the claims experience of plan sponsors or individuals or
any health status-related factor relating to any participants or beneficiaries covered or
new participants or beneficiaries who may become eligible for such coverage
✔✔When discontinuing a policy, an insurer must provide notice in writing to each plan
sponsor or insured of the discontinuation at least __________ before the date it will be
discontinued. - ✔✔90 calendar days
✔✔An issuer may elect to discontinue offering all health insurance coverages in the
individual, small group, or large group market if: - ✔✔- the issuer provides notice in
writing to the applicable state authority and to each plan sponsor or individual of the
discontinuation at least 180 days before the date of coverage discontinuation
- all health insurance policies issued or delivered for issuance in the state in the
applicalbe market are discontinued and not renewed
✔✔In order to discontinue coverage in all markets, the insurer must provide notice in
writing to the applicable state authority and all insured's at least __________ before the
date of discontinuation. - ✔✔180 calendar days
✔✔A Health Insurance Exchange may cancel an enrollee's coverage in the event of any
of the following: - ✔✔- the enrollee is no longer eligible for coverage
- premiums are no longer being paid and grace periods have been exhausted
- the enrollee's coverage has been rescinded
- the health plan terminates or is decertified
- the enrollee changes from one plan to another
, ✔✔If an agent or broker engages in __________ during the replacement of health
insurance contracts in Arizona, the agent may be exposed to errors and omissions
liability as well as having their insurance license suspended or revoked. -
✔✔Misrepresentation
✔✔Uniform Individual Accident and Sickness Policy Provisions Law - ✔✔Established
standard provisions that are to be included in all individual health insurance policies in
all states. The purpose of these provisions is to define the rights and duties of both the
insurer and the policy holder. Any of the provisions may be reworded y the insurer, so
long as the modification does not make the provision less favorable to the policy holder
or beneficiary.
✔✔Entire Contract Provision - ✔✔states that the policy, together with a copy of the
signed application and attached riders and amendments, constitutes the entire contract.
No changes may be made to the policy without the express written agreement of both
parties, and any changes must also be made a part of the contract.
✔✔Who has the authority to make any changes to a policy? - ✔✔Only an executive
officer of the company, not an agent.
✔✔Time Limit on Certain Defenses Provision - ✔✔no statement or misstatement
(except fraudulent misstatements) made in the application at the time of issue will be
used to deny a claim after the policy has been in force for two years
✔✔Grace Period - ✔✔the period of time after the premium due date in which premium
payments may still be paid before the policy lapses for nonpayment of the premium
✔✔In most cases the grace period cannot be less than __________ for weekly
premium policies (industrial policies), __________ for monthly premium policies and
__________ for all other modes. Coverage will continue in force during the grace
period. - ✔✔7 days/10 days/31 days
✔✔Per Affordable Care Act regulations, a Qualified Health Plan issuer must provide a
__________ if an enollee receiving advance payments of the premium tax credit has
previously paid at least one full month's premium during the benefit year. - ✔✔grace
period of 3 consecutive months
✔✔During a grace period, the issuer must: - ✔✔- pay all appropriate cliams for services
provided to the enrollee during the first month of the grace period; and may pend claims
for services in the second and third months
- notify the Department of Health and Human Services of nonpayment
- notify providers of the possibility for denied claims when an enrollee is in the second
and third months of the grace period
ANSWERS AND QUESTIONS SET A+
✔✔What are the sources of underwriting information? - ✔✔- Application
- MEdical Information Bureau
- Medical Exams and Lab Tests
- Genetic Testing
- Rating Factors
✔✔Producer Report - ✔✔the report that the agent/producer is involved in completing
that asks questions about the length of time that the applicant has been known to the
agent, an estimate of the applicant's income and net worth, and whether the agent
knows of any reason that the contract should not be issued; does not become part of
the entire contract
✔✔Reports on previous insurance information can be obtained from the __________.
Insurers can report on an applicant and receive coded information from any other
applications for insurance submitted to other insurers. - ✔✔Medical Information Bureau
✔✔Information from the __________ cannot be used in and of itself to decline a risk,
but it can give the underwriter important additional information. - ✔✔Medical Information
Bureau
✔✔__________, when required by the insurance company, are conducted by
physicians or paramedics at the insurance companies expense. They are usually not
required in regard to health insurance, thus stressing the importance of the agent in
recording medical information on the application. - ✔✔Medical examinations
✔✔If an insurer requires an applicant to take __________, the insurer must first obtain
the applicant's written consent for the test. The consent form must explain the purpose
of te test, and inform the applicant about the confidentiality of the results. - ✔✔an HIV
test
,✔✔__________ may not be performed without specific, written informed consent of the
subject Results are confidential and may not be released to any party without the
expressed consent of the subject. - ✔✔Genetic testing
✔✔Gene Products - ✔✔refer to gene fragments or DNA sequence information
✔✔Genetic Test - ✔✔an analysis of an individual's DNA, gene products or
chromosomes; intended to indicate susceptibility to illness or other disorders
✔✔When developing remium rates fr a qualified health plan in the individual and small
group markets, insurers may only consider the following rating factors: - ✔✔- whether
the plan or coverage covers an individual or a family
- age (subject to restrictions)
- tobacco use (subject to restrictions)
- rating area (by geographic boundaries)
✔✔What are the categories for Classification of Risks? - ✔✔- preferred
- standard
- substandard
✔✔Preferred - ✔✔risks that reflect a reduced risk of loss and are covered at a reduced
rate
✔✔Standard - ✔✔risks that reflect average exposures and may be insured at standard
rates and premiums
✔✔Substandard - ✔✔risks that reflect an increased risk of loss to the insurer; these
applicants may be able to obtain health insurance coverage at an increased premium
✔✔Why would an applicant be rated substandard? - ✔✔- poor health
- dangerous vocation
- dangerous avocation
✔✔Who's responsibility is it to carefully compare the benefits, limitations and exclusions
found in the current and proposed replacement policy? - ✔✔The agent's
✔✔Who needs to make sure that the current policy is not cancelled before the new
policy is issued? - ✔✔The agent
✔✔Underwriting - ✔✔the process of reviewing applications for insurance and the
information on the application
✔✔Why is underwriting important when replacement is involved? - ✔✔It is the
underwriter's duty to evaluate risk and decide whether or not a person is eligible for
,coverage. The insured may be under the impression that a replacing policy is in their
best interest, but after being evaluated by an underwriter, where premium and risk are
exchanged, an insured may not be paying the same premium or receiving the same
benefits.
✔✔Pre-existing Condition - ✔✔a medical condition for which the insured sought medical
advice or treatment within a specified period of time prior to the policy being issued.
✔✔Health conditions covered under the current policy may not be covered under the
new policy because of __________ limitations, or new waiting periods may be required
in a new policy. - ✔✔Pre-existing condition
✔✔If an issuer decides to discontinue a particluar product, the issuer must: - ✔✔-
provide notice in writing to each plan sponsor or insured of the insured of the
discontinuation at least 90 days before the date it will be discontinued
- offer to each plan sponsor or individual the option to purchase any other health
insurance coverage currently being offered by the issuer
- act uniformly without regard to the claims experience of plan sponsors or individuals or
any health status-related factor relating to any participants or beneficiaries covered or
new participants or beneficiaries who may become eligible for such coverage
✔✔When discontinuing a policy, an insurer must provide notice in writing to each plan
sponsor or insured of the discontinuation at least __________ before the date it will be
discontinued. - ✔✔90 calendar days
✔✔An issuer may elect to discontinue offering all health insurance coverages in the
individual, small group, or large group market if: - ✔✔- the issuer provides notice in
writing to the applicable state authority and to each plan sponsor or individual of the
discontinuation at least 180 days before the date of coverage discontinuation
- all health insurance policies issued or delivered for issuance in the state in the
applicalbe market are discontinued and not renewed
✔✔In order to discontinue coverage in all markets, the insurer must provide notice in
writing to the applicable state authority and all insured's at least __________ before the
date of discontinuation. - ✔✔180 calendar days
✔✔A Health Insurance Exchange may cancel an enrollee's coverage in the event of any
of the following: - ✔✔- the enrollee is no longer eligible for coverage
- premiums are no longer being paid and grace periods have been exhausted
- the enrollee's coverage has been rescinded
- the health plan terminates or is decertified
- the enrollee changes from one plan to another
, ✔✔If an agent or broker engages in __________ during the replacement of health
insurance contracts in Arizona, the agent may be exposed to errors and omissions
liability as well as having their insurance license suspended or revoked. -
✔✔Misrepresentation
✔✔Uniform Individual Accident and Sickness Policy Provisions Law - ✔✔Established
standard provisions that are to be included in all individual health insurance policies in
all states. The purpose of these provisions is to define the rights and duties of both the
insurer and the policy holder. Any of the provisions may be reworded y the insurer, so
long as the modification does not make the provision less favorable to the policy holder
or beneficiary.
✔✔Entire Contract Provision - ✔✔states that the policy, together with a copy of the
signed application and attached riders and amendments, constitutes the entire contract.
No changes may be made to the policy without the express written agreement of both
parties, and any changes must also be made a part of the contract.
✔✔Who has the authority to make any changes to a policy? - ✔✔Only an executive
officer of the company, not an agent.
✔✔Time Limit on Certain Defenses Provision - ✔✔no statement or misstatement
(except fraudulent misstatements) made in the application at the time of issue will be
used to deny a claim after the policy has been in force for two years
✔✔Grace Period - ✔✔the period of time after the premium due date in which premium
payments may still be paid before the policy lapses for nonpayment of the premium
✔✔In most cases the grace period cannot be less than __________ for weekly
premium policies (industrial policies), __________ for monthly premium policies and
__________ for all other modes. Coverage will continue in force during the grace
period. - ✔✔7 days/10 days/31 days
✔✔Per Affordable Care Act regulations, a Qualified Health Plan issuer must provide a
__________ if an enollee receiving advance payments of the premium tax credit has
previously paid at least one full month's premium during the benefit year. - ✔✔grace
period of 3 consecutive months
✔✔During a grace period, the issuer must: - ✔✔- pay all appropriate cliams for services
provided to the enrollee during the first month of the grace period; and may pend claims
for services in the second and third months
- notify the Department of Health and Human Services of nonpayment
- notify providers of the possibility for denied claims when an enrollee is in the second
and third months of the grace period
